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General NPI Number Information
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NPI Number | 1861840464
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Entity Type | Individual
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Provider Name | WILLIAM BOLSTER D.C.
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Gender | Male
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Dates
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Enumeration Date | 05/25/2016
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Last Update Date | 07/14/2016
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Provider Practice Location Address
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Address Line | 524 W 5TH AVE
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City | NAPERVILLE
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State | IL
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Zip | 60563-2901
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Country | US
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Telephone | 630-362-6055
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Fax |
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Provider Business Mailing Address
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Address Line | 2211 HAIDER AVE
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City | NAPERVILLE
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State | IL
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Zip | 60564-5399
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Country | US
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Telephone | 630-362-6055
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 038.012971
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License Number State | IL
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